In summary

A CalMatters investigation unpacks the factors that result in thousands staying in California nursing homes against their will.


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You can check out anytime you like, but you can never leave.

That iconic line from “Hotel California” sums up the situation in which many poor nursing home residents find themselves: Despite their wish to return to the community — and despite the U.S. Supreme Court granting them the civil right to do so if they are able and willing — many end up stranded in long-term care facilities indefinitely.

A stunning investigation from CalMatters’ Jesse Bedayn unpacks the interlocking factors that have hindered thousands of Californians from leaving their nursing homes, a problem that took on new urgency amid the pandemic:

  • The federal government requires nursing home staff to ask residents four times a year about their health and welfare, including whether they would like to leave. If they respond “yes,” the facility is supposed to connect them to a program to help fund and organize their transition back into the community.
  • A 2016 federal report found most nursing homes “never ask, or nearly never ask” residents the required questions.
  • And the California Department of Public Health doesn’t penalize facilities that don’t follow through on residents’ transition requests. In 2020, only one-third of residents’ nearly 14,500 requests to move back into the community were fulfilled.
  • Nor does the Department of Public Health regulate how quickly a facility should refer a resident to a transition program. The average wait time for a transition in California is 7 months, and the average wait time residents spend on affordable housing waitlists is 2.5 years.
  • And many low-income residents can’t afford to leave nursing homes: Once in long-term care, every cent of their Social Security income — save for a $35 monthly allowance — is taken to pay for the daily costs of living in the facility.

“You would be shocked by the number of residents who could live in a much less institutional level of care,” said Nicole Howell, who investigates nursing home complaints as the Contra Costa County ombudsman. “People just end up languishing there.”

When Bradley Fisher, a 63-year-old retired mechanic, returned to the community after living in a Bay Area nursing home for 14 years, his assessment was clear: “It’s the most peaceful I’ve ever been. I feel like a knot in my gut has been removed.”


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The coronavirus bottom line: As of Tuesday, California had 6,910,991 confirmed cases (+1.4% from previous day) and 77,345 deaths (+0.1% from previous day), according to state data. CalMatters is also tracking coronavirus hospitalizations by county.

California has administered 67,900,959 vaccine doses, and 72.3% of eligible Californians are fully vaccinated.


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1. Ambulance bottlenecks multiply across state

Ambulances are parked outside Sutter Medical Center in Sacramento on Jan. 13, 2022. Photo by Miguel Gutierrez Jr., CalMatters

From CalMatters justice reporter Byrhonda Lyons: It should take just 20 minutes to transfer a patient from an ambulance to the hospital, but last year patients served by the Sacramento Fire Department waited for over two hours more than 700 times, Assistant Chief Eric Saylors said in a Wednesday hearing before the state Assembly’s Emergency Management Committee. “This is nothing short of criminal,” Saylors said, while emphasizing it wasn’t entirely a “COVID problem — it’s been going on for more than a decade.”

Across the state, a persistent patient surge paired with omicron’s impact on the health care workforce has resulted in worsening ambulance bottlenecks. As California’s state epidemiologist Dr. Erica Pan noted last week, fewer hospital workers means less patients admitted from the emergency room, which means ambulances have to wait longer to drop off patients, which means new 911 callers face longer response times. A couple of other data points:

2. Workers, businesses in tough spot

Brittannie Gulley, a cashier at Stater Bros. Market, poses for a portrait in Norwalk on Jan. 13, 2022. Photo by Pablo Unzueta for CalMatters

Will California revive extra paid sick leave for COVID-19, and if so, when? That question is top of mind for both employees and employers alike, CalMatters’ Alejandro Lazo reports: Essential workers are weathering another, even more infectious virus surge without the protections they had at the beginning of the pandemic, whereas business groups worry that reinstating those mandates will only slow down California’s already sluggish economic recovery. Meanwhile, the gap between the state’s haves and have-nots appears to be widening: As of November, California’s low-wage sectors were down 517,000 jobs from before the pandemic compared to 309,000 jobs in high-wage sectors.

3. Inside California’s rare new preserve

A view from the Tehachapi Mountains on Jan 12, 2022. Photo by Julie Leopo for CalMatters

And now for some good news: The Nature Conservancy last month finalized its latest purchase in the Tehachapi foothills — a 112-square-mile preserve that will help connect Los Angeles and the San Joaquin Valley and serve as a haven for wildlife and a laboratory for scientists, CalMatters’ Julie Cart reports. The more than $65 million acquisition — buoyed by about $15 million in state grants and partnerships — protects a rare, undeveloped region of California that’s home to everything from condors to rubber boas and ranges from desert to snowy mountains.


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CalMatters commentary

CalMatters columnist Dan Walters: Newsom once promised to bring single-payer health coverage to the state, but he’s now content to settle for something less.

Don’t give up now: The state bar is considering whether to disband or suspend a task force exploring how to close the justice gap for many Californians, writes Jason Solomon of Stanford Law School’s Center on the Legal Profession.

It’s time for a seaweed revolution: Why would the country’s most progressive state discourage projects that seek to feed people and help drought-stricken farmers, all with methods that enhance the quality of our environment? asks Brandon Barney, co-founder of Primary Ocean.


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Other things worth your time

California just distributed nearly 21 million N95 masks for schools. Here’s where they went. // KCRA

Yes, U-Haul ran out of trucks for people moving out of California. // Snopes

Wildfire risk in California drives insurers to pull policies for pricey homes. // Wall Street Journal

Celeb-heavy Los Angeles suburb gets tough on water wasters. // Associated Press

California gives non-housing projects a shot at cheap financing. // Bloomberg

Proposed Oakland business tax changes would hit larger companies harder. // San Francisco Chronicle

California plan to license nonlawyers draws heated response. // Reuters

Spears case drives California bid to limit conservatorships. // Associated Press

California AG opens investigation into Santa Clara County Sheriff’s Office over allegations of civil rights violations. // San Francisco Chronicle

Surveillance showdown: Mayor Breed, supervisors clash over police access to cameras. // San Francisco Standard

Police break up fracas at Orange County Republican meeting. // Orange County Register

Stanford VP and professor sue university in fentanyl overdose death of their son. // San Francisco Chronicle

City opioid epidemic: Fewer people died of overdoses in 2021 than 2020, but crisis still unprecedented. // San Francisco Chronicle

California to remove Mayan affirmation from ethnic studies. // San Diego Union-Tribune

Sales crawl ahead for fraud-linked developer’s Bay Area real estate. // Mercury News

Highway 37 could be fully underwater as soon as 2040. // SFGATE

USC fraternity parties can return, but with guards near bedrooms to prevent sexual assaults. // Los Angeles Times


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Emily Hoeven writes the daily WhatMatters newsletter for CalMatters. Her reporting, essays, and opinion columns have been published in San Francisco Weekly, the Deseret News, the San Francisco Business...